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Brain-dead pregnant woman must be taken off life support, judge rules

John Peter Smith Hospital in Fort Worth, Texas has been keeping Marlise Munoz on life support against her family’s wishes.

Erick Munoz arrives for a court hearing Friday to decide if his pregnant, brain-dead wife is to be removed from life support at a Texas hospital. By Friday afternoon, the judge ordered the hospital to remove Marlise Munoz from life support by Monday evening. (Ron T. Ennis / The Associated Press)

Marlise Munoz, seen in a photo with her husband Erick and their son Mateo at 3 weeks old, fell brain dead from complications of what appeared to be a blood clot in November while pregnant. A Texas judge ruled Friday that she be taken off life support. (Ron T. Ennis / The Associated Press)

By Nomaan MerchantAssociated Press

Fri., Jan. 24, 2014

FORT WORTH, TEXAS—A judge has ordered a Texas hospital to remove life support for a pregnant, brain-dead woman, siding with the husband and family in a case that has drawn international attention.

Judge R.H. Wallace Jr. issued the ruling Friday in the case of Marlise Munoz, 33, who is being kept alive in a hospital in Fort Worth against her family’s wishes. The judge gave the county-owned hospital until 5 p.m. Monday to remove life support.

“This is tragic and very difficult case,” the judge said before ruling that the state law in question did not apply to Munoz because she was dead.

“There is no happiness in this result, only a sigh of relief that this family can now move on to the task of burying Marlise Munoz,” said lawyer Heather King, who represented the family. “We feel that today justice was done.”

The case has raised questions about end-of-life care and whether a pregnant woman who is considered legally and medically dead should be kept on life support for the sake of a fetus. It also has caught the attention of both sides of the abortion debate, with anti-abortion groups arguing Munoz’s fetus deserves a chance to be born.

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Munoz was 14 weeks pregnant when her husband found her unconscious on her kitchen floor on Nov. 26, possibly due to a blood clot in her lung.

Erick Munoz, 26, said he and his wife’s parents were told by the hospital that she was brain-dead. They said they had asked the doctors to remove her from respirators, as Ms. Munoz had urged them to do if she was ever in that situation.

Munoz said he and his wife are paramedics who were clear about not wanting life support if they ever ended up in a vegetative state.

His lawyer argued that keeping the woman alive would set a dangerous precedent for similar cases in the future.

Doctors at John Peter Smith Hospital refused to end life support, insisting the hospital had to protect the life of the unborn child. Hospital officials said they were bound by a state law that prevents them from withdrawing or withholding “life-sustaining treatment” from a pregnant patient. Her husband filed suit asking a judge to order the doctors to remove her from the machines.

The hospital said in a statement Friday that it “appreciates the potential impact of the consequences of the order on all parties involved” and was deciding whether to appeal.

Several experts interviewed by The Associated Press have said the hospital was misapplying the law.

But lawyers for the J.P.S. Health Network, the publicly financed county hospital district that runs John Peter Smith Hospital, argued Friday that the law had been applied correctly. It was not clear whether the hospital would appeal, but the Monday deadline gives officials time to consider whether to do so.

Earlier this week, Erick Munoz’s lawyers said the fetus, now believed to be at about 22 weeks’ gestation, is “distinctly abnormal,” with lower extremities deformed, and suffers from a number of other serious health conditions including water on the brain and heart problems. They said they based that statement on medical records they had received from the hospital.

Jessica Hall Janicek, one of the lawyers representing the Munoz family, signed a document filed Friday stating that the fetus gestating inside Marlise Munoz’s body at the time of the hearing was not viable. Discussion of the fetus’s condition and the law that has prevented life-supporting aid being provided to Marlise Munoz were at the centre of the hearing.

Janicek and King argued the hospital was misconstruing the Texas Health and Safety Code by failing to read the relevant sections in conjunction with the entirety of the code.

First, they said that when one section of the code is applied, Marlise Munoz would be considered already dead because “there is irreversible cessation of the person’s spontaneous respiratory and circulatory functions.” So the hospital would not be removing life-sustaining treatment.

The lawsuit also argued that even if the hospital believes the health code applies to Marlise Munoz, the Texas Advance Directive Act does not extend the prohibition of withholding or withdrawing life-sustaining support to the unborn child.

Not much is known about fetal survival when mothers suffer brain death during pregnancy. German doctors who searched for such cases found 30 instances of survival over nearly 30 years, according to an article published in the journal BMC Medicine in 2010.

But those mothers were further along in pregnancy — 22 weeks on average — when brain death occurred.

Thomas Mayo, an associate law professor at Southern Methodist University who helped draft the state law used to keep Marlise Munoz alive, said lawmakers never discussed it being applied to a brain-dead person.

“It never would have occurred to us that anything in the statute applied to anyone who was dead,” Mayo said.

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